Provider Demographics
NPI:1114067998
Name:DAMATO, MARK R (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:DAMATO
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:4450 SOUTH TAMIAMI TRAIL
Mailing Address - Street 2:SUITE B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231
Mailing Address - Country:US
Mailing Address - Phone:941-927-7009
Mailing Address - Fax:941-929-9715
Practice Address - Street 1:4450 SOUTH TAMIAMI TRAIL
Practice Address - Street 2:SUITE B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231
Practice Address - Country:US
Practice Address - Phone:941-927-7009
Practice Address - Fax:941-929-9715
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2014-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLCH4427111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
70392Medicare PIN